Who is at risk for dropout from group cognitive-behavior therapy for insomnia?

Objective: The aim of the present study was to identify characteristics of patients who are at risk for dropout from a seven-session group cognitive-behavior therapy for insomnia (CBT-I) in a clinical setting using the receiver operating characteristic curve (ROC) approach. Methods: Two separate ROC analyses were conducted using predictor variables taken from questionnaire packets and sleep diaries collected at baseline including age, gender, Beck Depression Inventory (BDI), Morningness-Eveningness Questionnaire, Beliefs and Attitudes about Sleep, use of sleep medication, sleep onset latency, wake time after sleep onset, and total sleep time (TST). Results: The first ROC analysis was conducted on the entire sample of 528 patients with treatment completion vs. dropout (noncompletion) as the outcome variable. No significant predictor variables were found in this analysis. The second ROC analysis was conducted on the 211 patients who did not complete treatment with early termination (prior to fourth session) vs. late termination (at or after fourth session) as the outcome variable. The results revealed that patients who reported an average baseline TST < 3.65 h were at greatest risk for early termination. Sixty percent of patients in this group terminated early compared to 9.3% of patients with TST >= 3.65 h. Among patients with TST >= 3.65 h, 22% of those with BDI scores >= 16 were early dropouts compared to 4.3% of those who reported BDI < 16. Conclusion: These findings indicate that short sleep duration and elevated symptoms of depression at baseline are associated with increased risk of early termination from CBT-I. (c) 2008 Elsevier Inc. All rights reserved.